GI Flashcards
cirrhosis - end stage / late stage
compared to compensated cirrhosis
compensated - enough healthy cells
decompensated not longer enough healthy cells
hepatic encephalopathy ascites and esophageal / gastric variceal haemorrhage
compensated cirrhosis symptoms
loss of appetite
fatigues
muscle cramps
bruising and excessive bleeding as not enough clotting factors produced
why do caput medusae occur in cirrhosis?
cirrhosis > portal hypertension > engorged paraumbilical veins on abdomen wall
can gastroenteritis cause metabolic acidosis?
yes but ketones are not elevated
but alcholic ketoacidosis can also occur when glucose is not too low
why do alcoholics risk ketoacidosis?
treatment?
not reguarly eating / body breaks down body fat
also episodes of vomit
met acidosis > elevated anion gap> elevated serum ketones > normla or low glucose concentartion
infusion of saline and thiamine
avodi wernicke encephalopathy
IBD key differences
crohns has _____ _, _______,_______
crohns : skip lesions , granulomas, mucosa ro serosa all layers impacted, cobblestone appearance
UC: only upto sub mucosa is inflammed
crypt abscess
pseudopolyps
most common causative agent for peritonitis
what would be the neutrophil count on paracentesis ?
e.coli
>250 cells/uL
cefotaxime
Primary sclerosing cholangitis
hx
o/e
presents with what disease?
blood test results?
management
presents UC
pruritism - bilirubin
alt, ggt raised - biliary tree involvement
MRCP
PSC
Associations
Features
Investigation
UC
Crohns
HIV
jaundice, RUQ pain, bili raised and alp, fatigue
p-anca +
beaded appearance of biliary tree
where does mesenteric ischaemia present?
due to ?
pain?/ presentation
small bowel
embolic event
sudden onset, severe pain
urgent surgery
high mortality
ischaemic colitis
presents?
large bowel
thumbprinting
transient less severe symptoms / bloody diarrhoea
conservative management
bowel ischaemia risk factors
features
blood test finding
investigation?
atrial fibrillation
endocarditis
malignancy
smoking, htn, DM
cocaine
rectal bleed
diarrhoea
fever
elevated wcc and lactic acidosis
ct
why is thumbprinting seen in ischaemic colitis ?
abdominal xray sign due to mucosal oedema and haemorrhage
management of crohns- remission
azathioprine / mercaptopurine
first line treatment for UC
mesalazine
what is serious complication of mesalazine
how would this come up in an mcq
agranulocytosis
sore throat, fever w taking this drug for uc
A patient who is taking aminosalicylates and becomes unwell with a sore throat, fever, fatigue or bleeding gums needs an ?
urgent full blood count to rule out agranulocytosis.
Primary biliary cholangitis is associated with _____ ________ does / does not result in progressive obstructive jaundice.
such as Sjogren’s and does not result in progressive obstructive jaundice.
zollinger - ellison syndrome
excessive levels of gastrin
men type 1 syndrome
duodenal ulcers
diarrhoea
malabsorption
fasting gastrin levels
secretin stimulation test
budd chiari syndrome
hepatic vein thrombosis
haematological disease; polycythaemia vera / pregnancy, cop
TRIAD- sudden abdo pain, ascites, tender hepatomegaly
portal vein thrombosis
no hepatomegaly
thrombus before liver
affects vein supplying liver
pseudomembranous colitis which abx
ceftriaxone
co-amoxiclav
ciprofloxacin
clindamycin
crohns disease
- perianal fistulae
- investigation of choice
MRI pelvis
Treatment - Crohns
remission
ongoing
what needs to be assessed before giving dmards?
remission - prednisalone / dexamethasone
enteral feeding
2nd line :5-asa drugs / aminosalicylates : MESALAZINE
maintaining remission : azathiopurine
TPMT activity - thiopurine methytransferase activity
how if TPMT assessed
blood test
if your TPMT is low you should not receive aza
hepatitis screen results for someone that has immunity from a vaccine?
HBsAg
anti-HBc
anti-HBs
HBsAg-
anti hbc -
anti hbs +
HBsAg
anti-HBc
anti-HBs
what do these mean?
HBsAG - hepatitis b surface antigen- suggests current infection / infectious
can be either acute / chronic infection
Hepatitis core antibody : this would be present in an actual infection not vaccine
hepatitis surface antibody - vaccine / natural infection dependant on other results
HBsAg
anti-HBc
anti-HBs
what do these mean?
HBsAG - hepatitis b surface antigen- suggests current infection / infectious
can be either acute / chronic infection
Hepatitis core antibody : this would be present in an actual infection not vaccine
hepatitis surface antibody - vaccine / natural infection dependant on other results
acute / chronic infected w Hep B ?
HBsAG - positive
hep b serology
HBsAg [acute disease1-6mo] - first marker > production of anti-hbs
anti-HBs always suggests immunity so if your hep is chronic / not resolving - CHRONIC disease
anti-HBc -caught the disease / core previous / current
IgM - current / 6mo
IgG- older
HbeAg- breakdown of core antigen so marker of infectivity
coeliac disease
what condition is it associated with?
what condition can occur as a complication?
type 1 diabetes
autoimmune thyroid disease
dermatitis herpetiformis itchy blistering skin manifestation
a rash that occurs on extensor surfaces like knees , elbows
the rash is itchy, vesicular
what is this rash diagnosis?
and what is the cause?
dermatitis herpetiformis
caused by coeliac disease
what is the most common intra abdominal abscess
sub phrenic
anti emetics
cyclizine
h1 receptor antagonist
d2 receptor antagonist - anrti emetic
meoclopramide
5ht3 receptor antagonist
ondansetron
autoimmune hepatitis
ama and ana antibodies
cholera management
fluid replacement
abx doxycycline
anal fissure >6 weeks
chronic
painful ictal bleeding?
anal fissure
acute anal fissure mx?
soften stool
high fibre
high fluid intake
laxatives > lactulose
vaseline before defecating
topical anaesthetics
analgesia
chronic anal fissure?
topical GTN
or surgery or botulinum toxin
haemorrhoids
Location: 3, 7, 11 o’clock position
Internal or external
Treatment: Conservative, Rubber band ligation, Haemorrhoidectomy
external haemorrhoids
prone to thrombosis
and painful
internal haemorrhoids
painless
above dentate line
examination reveals a purplish, oedematous, tender subcutaneous perianal mass
Acutely thrombosed external haemorrhoids
outpatient treatment for haemorrhoids
rubber band ligation
injection sclerotherapy
Patients may describe pain around the anus, which may be worse on sitting;
They may have also discovered some hardened tissue in the anal region;
There may be pus-like discharge from the anus;
If the abscess is longstanding, the patient may have features of systemic infection
what is it caused by commonly?
perianal abscess
e coli
gold standard in imaging anorectal abscesses
MRI and transperineal ultrasound can be useful tools, with the former being the
perianal abscess treatment
incision and drainage
appendicitis scoring system?
alvarado
haematemesis scoring system?
Blatchford - >6
Rockall
coeliac disease - derm condition?
dermatitis herpetiformis
Mx: dapsone: abx
definitive test for coeliac?
duodenal biopsy
Diverticular complication?
localised perforation= abscess
faecal peritonitis
stricture
per rectum bleeding
investigation for diverticular disease?
CT scan
painless jaundice with a palpable mass in RUQ
what is investigation of choice
CT is the investigation of choice
in a RUQ pain / jaundice what is imaging of choice?
USS
always
in MRCP
how do you differentiate between large and small bowel obstruction?
in small bowel vomiting precedes abdominal distension
UC risk factor for which cancer?
what if pt also has microcytic anaemia
right sided colon cancer
gastrograffin
use?
diagnostic and therapeutic
opens up small bowel obstruction
alarm bells for colonoscopy
per rectum - mixed with stool , tenesemus , urgency
weight loss
iron deficiency
recent change in bowel habits
young pt
intermittent not progressive
both solids/ fluids
with a short hx?
achalasia
fluid challenge
IV bolus 250-500mL / 30 mins
REASSESS
maintenance fluids?
restore 2.5l fluid
100mM na+
70mM K+
Bag 1: 1 L of normal saline (=1 L of H O, 154 mM Na+, 154 mM Cl−) plus 20 mM K+, IV over 8 hours. 2
− Bag 2: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2
− Bag 3: 1 L of 5% dextrose (=1 L of H O, 50 g of dextrose), plus 20 mM K+, IV over 8 hours. 2
− Total: 3 L of H O, 154 mM Na+, 60 mM K+ over 24 hours.
replacement fluids
Fever: febrile patients need an extra 500 mL of fluid for every 1oC above 37oC.
− Burns patients: patients with burns need extra fluids and this can be calculated using the Parkland
formula:
Fluids (mL) = 4 × weight (kg) × % surface area burnt
